Postmenopausal vaginal atrophy: evaluation of treatment with local estrogen therapy

Abstract

Postmenopausal vaginal atrophy, resulting from decreased estrogen production, frequently requires treatment. Estrogen preparations provide the most effective treatment; local application is preferred to systemic drugs when treating only vaginal symptoms. As local estrogen therapies have comparable efficacy, this study aimed to understand treatment practices, assess experiences with different forms of local estrogen-delivering applicators, and evaluate satisfaction. Women who were US residents aged ≥18 years, menopausal (no spontaneous menstrual period for ≥1 year or with a double oophorectomy), and receiving local estrogen therapy for 1–6 months (vaginal cream [supplied with a reusable applicator] or vaginal tablets [supplied with a single-use/disposable applicator]), completed an online questionnaire. Data from 200 women (100 cream users and 100 tablet users; mean therapy duration 3.48 months) showed that most stored medication in the room in which it was applied (88%) and applied it at bedtime (71%), a procedure for which cream users required, on average, more than twice the time of tablet users (5.08 minutes versus 2.48 minutes). Many cream users applied larger-than-prescribed amounts of cream, attempting to achieve greater efficacy (42%), or lower-than-recommended doses (45%), most frequently to avoid messiness (33%) or leakage (30%). More tablet users (69%) than cream users (14%) were “extremely satisfied” with their applicator. Postmenopausal women using local estrogen therapy were generally more satisfied with the application of vaginal tablets than cream. Patient satisfaction may help to facilitate accurate dosing. Positive perceptions of medication will help to optimize treatment, which, although not assessed in this study, is likely, in turn, to improve vaginal health.

Comparison of the Vaginal Microbiomes of Premenopausal and Postmenopausal Women

“…Decreased ovary function during menopause results in lower levels of circulating estrogen, which often leads to various symptoms such as hot flashes, night sweats, decreased cognitive functions and mood changes that are experienced by women during the years immediately preceding and during menopause (Takahashi and Johnson, 2015). Additionally, genitourinary tract changes associated with vulvovaginal atrophy (VVA) are common and affect at least 50% of menopausal women (Santoro and Komi, 2009; Nappi and Kokot-Kierepa, 2010, 2012; Simon et al, 2013; Minkin et al, 2014). The most common signs of VVA include dryness, redness, itching, and dyspareunia, with occasional discharge and/or bleeding (Bachmann and Nevadunsky, 2000).…”

The REJOICE trial: a phase 3 randomized, controlled trial evaluating the safety and efficacy of a novel vaginal estradiol soft-gel capsule for symptomatic vulvar and vaginal atrophy

“…8 Creams require a reusable applicator (which may be unsanitary) and can be messy, inconvenient, and difficult to properly administer. 13,14 Currently available vaginal tablets also have the inconveniences of an applicator which may be difficult to use and may cause vaginal abrasions. 15 Vaginal discharge lasting for days and perceived lack of efficacy have also been associated with vaginal tablets.…”

Estradiol softgel inserts for the treatment of VVA symptoms: an expert opinion

“…Despite the efficacy and safety of various vaginal estrogen therapies for VVA, studies document women's concerns related to route of administration, lack of convenience, and safety regarding systemic exposure and long-term use [5,[25][26][27]. Women surveyed in the REVIVE trial (Real Women's Views of treatment options for menopausal Vaginal changEs) cited several disadvantages of over-thecounter vaginal moisturizers and lubricants, prescription vaginal products, and vaginal creams, including difficulty administering the correct dose, inconvenience, and messiness, and incomplete effectiveness [5,26]. Vaginal rings can change position or dislodge [6], and women using them have reported difficulty with insertion and removal and concerns about infection and hygiene [25].…”

“…As a result, up to half (21% to 50%) of women have reported being dissatisfied with the currently available vaginal estrogen therapies [23,28]. Compliance with proper dosing is poor [26], and most women discontinue prescription treatments prematurely, within 45 days for vaginal creams and 103 days for vaginal tablets [29]. Women cited safety concerns, side effects, administration difficulties, messiness, and questionable efficacy as reasons why 38% chose not to refill prescriptions [27].…”